NPI | 1295899953 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101040397) |
Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: VA 0101040397) |
207NP0225X Dermatology Pediatric Dermatology (Licence: VA 0101040397) | |
207NS0135X Dermatology Procedural Dermatology (Licence: VA 0101040397) | |
Enumeration Date | 2006-12-20 |
Last Update Date | 2024-06-13 |